Continuous Pulmonary Artery Perfusion With Oxygenated Cold Blood And Ulinastatin Reduees Lung Injury For Patients With Moderate And High Risk After Cardiopulmonary Bypass

Background And ObjectiveWith the continue modification and development of cardiac surgical techniques and cardiopulmonary bypass material, such as heparin smear cardiopulmonary bypass piping, hemofiltration equipment such as arterial microthrombus filter,leukocyte filter, modified ultrafiltration, no blood prefilled,membrane oxygenator and deep hypothermia protection, as well as the application of various types of brain perfusion method. CPB-releated multiple organ injury have significantly reduced than before, but the release of various inflammatory mediators and activation of inflammatory cells due to cardiopulmonary bypass, resulting in a series of consecutive reactions or "waterfall-like effect", and eventually leading to a systemic inflammatory response syndrome, of all the organs of human body,lung is the earliest and the most vulnerable organs. the massive release of inflammatory cytokines after cardiopulmonary bypass may bring about alveolar and pulmonary interstitial edema, it may give rise to uneven hyperemia, hemorrhage, microthrombus formation, and also resulted in the limitations of atelectasis, diffuse inflammatory cell infiltration. As a consequence, it may lead to serious acute respiratory distress syndrome (ARDS) even cause death, how to find better approach to mitigate and prevent lung injury after cardiopulmonary bypass has become the focus of today’s cardiac surgery field. based on clinical trial, we now focusing on the mechanism of lung injury after cardiopulmonary bypass, aimed at discovering the effect of continuous pulmonary artery perfusion with ulinastatin oxygenation cold-blooded in the moderate and high-risk valve replacement patients.Methods60patients undergoing cardiac surgery valve replacement with moderate and high-risk patient (EuroScore≥4) were randomly divided into2groups:control group (C group) and ulinastatin group (U group). Ulinastatin group (U group, n=30) was given half of the total amount of ulinastatin (2X10U/kg) after incision and before CPB, the other half the amount was given during the CPB; The control group (C group, n=30) was given normal saline instead, clinical parameters, including intraoperative cardiac resuscitation, cardiopulmonary bypass time, after the parallel time, ascending aortic occlusion time, mechanical ventilation time, ICU time, complications, and the number of patient deaths, plasma tumor necrosis factor (TNF a), interleukin-6(IL-6), interleukin-8(IL-8), and the level of malondialdehyde (MDA) were measured before surgery, after surgery for8h,1d,3d and5d, alveolar-arterial oxygen difference (A-aDO2) and respiratory index (RI) were also calculated.. The clinical results and prognosis were observed.ResultsPostoperative hospital deaths and no significant difference in the incidence of complications, mechanical ventilation time, ICU and postoperative hospital stay without significant differences. Compared with the control group, the ulinastatin group after8h plasma TNF-a a, IL6, IL-8and MDA significantly decreased (P <0.05).ConclusionCardiopulmonary bypass can cause lung injury, ulinastatin can effectively inhibit the release of inflammatory cytokines during and after CPB, reduce lung injury, protect lung function in a certain extent.